Batchelor Institute graduation award

2016 nomination form

Koori Mail Award

The Koori Mail is a national newspaper published in Lismore, New South Wales which reports from an Indigenous perspective on people, issues and events that affect Indigenous people from all over Australia. This award is awarded in recognition of outstanding achievements by a student or students enrolled in Broadcasting or Media studies. This Award also encourages further study in the media field.If you have any queries about this award or the nomination process, please refer to the contact details at the top of the form.

SECTION 1 – NOMINEEDETAILS

Name of nominee
Title and position

SECTION 2 – Self-nomination

Nomination

Complete this section if you are nominating yourself for this award.

(a)Please explain in words the areas in you have demonstrated Outstanding Academic Achievement in Broadcasting or Media studies.

(b)How will this award benefit you?

Referee

Please provide the name and signature of a referee who supports your nomination for this award.

Name of referee______

Signature of referee______Date______

SECTION 3 – external nomination

Nomination

Complete this section if you are nominating someone else for this award.

(c)Please explain in words the areas in you have demonstrated Outstanding Academic Achievement in Broadcasting or Media studies.

(d)How will this award benefit the nominee?

Name of nominator______

Nominator signature______Date______

External body

Please provide the name and signature of an external bodywho supports your nomination for this award.

Name of external body______

External body signature______Date______

SECTION 4 – Checklist

Self-nomination

I have completed all questions

I have attached the academic history for the nominee (if self-nominating, please contact Student Progression on for a copy of your academic history)

I have attached supporting evidence

Signature of Referee

External nomination

I have completed all questions

I have attached the academic history for the nominee (if self-nominating, please contact Student Progression on for a copy of your academic history)

I have attached supporting evidence

Signature of external body

SECTION 5 – impact statement

The nominee must complete this section.

Please explain in no more than 1,000 words “What significant positive impact this course and this Scholarship and/or Award will have on my life”.

For example, you might explain why the course you are enrolling or re-enrolling for is important to you and your interests and ambitions, and how this Scholarship and/or Award will help you with this.

Your Impact Statement will be given to the Institute Scholarships and Awards Panel. It will be assessed together with Impact Statements from other applicants. The Scholarships and Awards will be awarded to the eligible applicant who demonstrates the most significant positive impact.

Please write your Impact Statement here

Continue on another sheet if there is insufficient space.

Send completed application to with subject:

Confidential nomination form.

SECTION 6 – Approval—OFFICE USE ONLY

Award winners must be approved by the Chairperson, Institute Scholarships and Awards Committee

Approved by

Signature______Date______

Authorising Officer – Manager, Student Services – Updated 27/01/2016Review 27/07/2017 Version 1.2Page 1 of 3